{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T04:52:22Z","timestamp":1761540742819},"reference-count":40,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2006,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Immune (or idiopathic) thrombocytopenic purpura (ITP) is commonly encountered by the practicing hematologist. Clinical management decisions have traditionally been guided by individual training and past experience. Input from the literature has been more from observational reports of case series than from scientific results of hypothesis-driven research. Practice guidelines and several surveys of clinical hematology practice have highlighted important questions in the field, and in the past 5 to 10 years both clinical and laboratory investigations have produced valuable new information. Thrombopoietin levels are normal or only slightly increased in ITP, and stimulation of thrombopoiesis appears to be a promising new therapeutic approach in clinical trials. Chronic, refractory ITP in children or adults remains a challenge for the hematologist. It is this group that has the greatest risk of serious bleeding, particularly among the elderly. The anti-B\u2013cell monoclonal antibody, anti-CD20, has shown benefit in phase I\/II clinical trials in patients who had failed a number of previous therapeutic modalities. The standard for clinical research into therapy for ITP has become evidence-based medicine, and more prospective, randomized clinical trials are being completed by multi-institutional study groups.<\/jats:p>","DOI":"10.1182\/asheducation-2006.1.402","type":"journal-article","created":{"date-parts":[[2006,11,22]],"date-time":"2006-11-22T23:14:02Z","timestamp":1164237242000},"page":"402-407","update-policy":"http:\/\/dx.doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":19,"title":["ITP in the 21st Century"],"prefix":"10.1182","volume":"2006","author":[{"given":"Diana S.","family":"Beardsley","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"234","reference":[{"key":"2019111702241833400_R1","doi-asserted-by":"crossref","unstructured":"George JN, Woolf SH, Raskob GE, et al. Idiopathic Thrombocytopenic Purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood. 1996;88:3\u201340.","DOI":"10.1182\/blood.V88.1.3.3"},{"key":"2019111702241833400_R2","unstructured":"Cines DB, Bussel JB. How I treat idiopathic thrombocytopenic purpura (ITP). Blood. 2004;106:2244\u20132251."},{"key":"2019111702241833400_R3","doi-asserted-by":"crossref","unstructured":"Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med. 2002;346:995\u20131008.","DOI":"10.1056\/NEJMra010501"},{"key":"2019111702241833400_R4","doi-asserted-by":"crossref","unstructured":"Blanchette VS, Carcao M. Childhood acute immune thrombocytopenic purpura: 20 years later. Semin Thromb Hemost. 2003;29:605\u2013617.","DOI":"10.1055\/s-2004-815628"},{"key":"2019111702241833400_R5","doi-asserted-by":"crossref","unstructured":"Provan D, Norfolk D, Bolton-Maggs P, et al. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children, and in pregnancy. Br J Hematol. 2003; 120:574\u2013596.","DOI":"10.1046\/j.1365-2141.2003.04131.x"},{"key":"2019111702241833400_R6","doi-asserted-by":"crossref","unstructured":"Aledort LM, Hayward CPM, Chen M-G, Nichol JL, Bussel J. Prospective screening of 205 patients with ITP, including diagnosis, serological markers, and the relationship between platelet counts, endogenous thrombopoietin, and circulating antithrombopoietin antibodies. Am J Hematol. 2004;76:205\u2013213.","DOI":"10.1002\/ajh.20104"},{"key":"2019111702241833400_R7","doi-asserted-by":"crossref","unstructured":"Barnard D, Woloski M, Feeny D, et al. for the Canadian Children\u2019s Platelet Study Group. Development of disease-specific, health-related, quality-of-life instruments for children with immune thrombocytopenic purpura and their parents. Pediatr Hematol Oncol. 2003;25:56\u201362.","DOI":"10.1097\/00043426-200301000-00011"},{"key":"2019111702241833400_R8","doi-asserted-by":"crossref","unstructured":"Buchanan GR, Adix L. Grading of hemorrhage in children with idiopathic thrombocytopenic purpura. J Pediatr. 2002; 141:683\u2013688.","DOI":"10.1067\/mpd.2002.128547"},{"key":"2019111702241833400_R9","doi-asserted-by":"crossref","unstructured":"Kuhne T, Imbach P, Bolton-Maggs PHB, et al. Newly diagnosed idiopathic thrombocytopenic purpura in childhood: an observational study. Lancet. 2001;358:2122\u20132125.","DOI":"10.1016\/S0140-6736(01)07219-1"},{"key":"2019111702241833400_R10","doi-asserted-by":"crossref","unstructured":"Bolton-Maggs PHB, Moon I. Assessment of UK practice for management of acute childhood idiopathic thrombocytopenic purpura against published guidelines. Lancet. 1997;350:620\u2013623.","DOI":"10.1016\/S0140-6736(97)04143-3"},{"key":"2019111702241833400_R11","doi-asserted-by":"crossref","unstructured":"Imbach P, Kuhne T, Muller D, et al. Childhood ITP: 12 months follow-up data from the prospective registry I of the intercontinental childhood ITP study group (ICIS). Pediatr Blood Cancer. 2006;46:351\u2013356.","DOI":"10.1002\/pbc.20453"},{"key":"2019111702241833400_R12","doi-asserted-by":"crossref","unstructured":"Portielje JE, Westendorp RGJ, Kluin-Nelemans HC, Brand A. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood. 2001;97:2549\u20132554.","DOI":"10.1182\/blood.V97.9.2549"},{"key":"2019111702241833400_R13","doi-asserted-by":"crossref","unstructured":"Frederiksen H, Schmidt, K. The incidence of idiopathic thrombocytopenic purpura in adults increases with age. Blood. 1999;94:909\u2013913.","DOI":"10.1182\/blood.V94.3.909.415k02_909_913"},{"key":"2019111702241833400_R14","doi-asserted-by":"crossref","unstructured":"Neylon AJ, Saunders PW, Howard MR, et al. Clinically significant newly presenting autoimmune thrombocytopenic purpurain adults: a prospective study of a population-based cohort of 245 patients. Br J Haematol. 2003;122:966\u2013974.","DOI":"10.1046\/j.1365-2141.2003.04547.x"},{"key":"2019111702241833400_R15","doi-asserted-by":"crossref","unstructured":"Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistently low platelet counts. Arch Intern Med. 2000;160:1630\u20131638.","DOI":"10.1001\/archinte.160.11.1630"},{"key":"2019111702241833400_R16","doi-asserted-by":"crossref","unstructured":"Terrell DR, Johnson KK, Vesely SK, George JN. Is immune thombocytopenic purpura less common among black Americans? Blood. 2005;105:1368\u20131369.","DOI":"10.1182\/blood-2004-09-3418"},{"key":"2019111702241833400_R17","doi-asserted-by":"crossref","unstructured":"Chang M, Nakagawa PA, Williams SA, et al. Immune thrombocytopenic purpura (ITP) plasma and purified ITP monoclonal autoantibodies inhibit megakaryocytopoiesis in vitro. Blood. 2002;102:887\u2013895.","DOI":"10.1182\/blood-2002-05-1475"},{"key":"2019111702241833400_R18","doi-asserted-by":"crossref","unstructured":"McMillan R, Wang L, Tomer A, Nichol J, Pistillo J. Suppression of in vitro megakaryocyte production by antiplatelet autoantibodies from adult patients with chronic ITP. Blood. 2003;103:1364\u20131369","DOI":"10.1182\/blood-2003-08-2672"},{"key":"2019111702241833400_R19","doi-asserted-by":"crossref","unstructured":"Nomura S, Dan K, Hotta T, Fujimura K, Ikeda Y. Effects of pegylated recombinant human megakaryocyte growth and development factor in patients with idiopathic thrombocytopenic purpura. Blood. 2002;100:728\u2013730.","DOI":"10.1182\/blood.V100.2.728"},{"key":"2019111702241833400_R20","doi-asserted-by":"crossref","unstructured":"Bussel JB, Kuter DJ, George JN, et al. Long-term dosing of AMG 531 is effective and well tolerated in thrombocytopenic patients with immune thrombocytopenic purpura. Blood. 2005;106:68a.","DOI":"10.1182\/blood.V106.11.220.220"},{"key":"2019111702241833400_R21","doi-asserted-by":"crossref","unstructured":"Crow AR, Lazarus AH. Role of Fc\u03b3 receptors in the pathogenesis and treatment of idiopathic thrombocytopenic purpura. J Pediatr Hematol Oncol. 2003;25:S14\u2013S18.","DOI":"10.1097\/00043426-200312001-00004"},{"key":"2019111702241833400_R22","doi-asserted-by":"crossref","unstructured":"McMillan R, Wang L, Tani P. Prospective evaluation of the immunobead assay for the diagnosis of adult chronic immune thrombocytopenic purpura (ITP). J Thromb Haemost. 2003;1:485\u2013491.","DOI":"10.1046\/j.1538-7836.2003.00091.x"},{"key":"2019111702241833400_R23","doi-asserted-by":"crossref","unstructured":"Berchtold P, Muller D, Beardsley D, et al. International study to compare antigen-specific methods used for the measurement of antiplatelet autoantibodies. Br J Haematol. 1997;96:477\u2013481.","DOI":"10.1046\/j.1365-2141.1997.d01-2064.x"},{"key":"2019111702241833400_R24","doi-asserted-by":"crossref","unstructured":"Fabris F, Scandellari R, Ruzzon E, Randi ML, Luzzatto G, Girolami A. Platelet-associated autoantibodies as detected by a solid-phase modified antigen capture ELISA test (MACE) are a useful prognostic factor in idiopathic thrombocytopenia purpura. Blood. 2004;103:4562\u20134564.","DOI":"10.1182\/blood-2003-09-3352"},{"key":"2019111702241833400_R25","doi-asserted-by":"crossref","unstructured":"Webster ML, Sayeh E, Crow M, et al. Relative efficacy of intravenous immunoglobulin G in ameliorating thrombocytopenia induced by anti-platelet GPIIbIIIa versus GPIb\u03b1 antibodies. Blood. 2006;108:943\u2013946.","DOI":"10.1182\/blood-2005-06-009761"},{"key":"2019111702241833400_R26","doi-asserted-by":"crossref","unstructured":"Samuelsson A, Towers TL, Ravetch JV. Anti-inflammatory activity of IVIG mediated through the inhibitory Fc receptor. Science. 2001;291:484\u2013486.","DOI":"10.1126\/science.291.5503.484"},{"key":"2019111702241833400_R27","unstructured":"Crow AR, Song S, Helgason CD, Humphries RK, Freedman J, Lazarus AH. Reversal of murine passive-immune thrombocytopenia by IVIg requires Fc gamma RIIB expression but not the SH2-containing inositol-5-phosphatase SHIP. Blood. 2001;98:2169."},{"key":"2019111702241833400_R28","doi-asserted-by":"crossref","unstructured":"Solanilla A, Pasquet J, Viallard J, et al. Platelet-associated CD154 in immune thrombocytopenic purpura. Blood, 2005; 105: 215\u2013218.","DOI":"10.1182\/blood-2003-07-2367"},{"key":"2019111702241833400_R29","doi-asserted-by":"crossref","unstructured":"Kuwana M, Nomura S, Fujimura K, et al. Effect of a single injection of humanized anti-CD154 monoclonal antibody on the platelet-specific autoimmune response in patients with immune thrombocytopenic purpura. Blood. 2003;103:1229\u20131236.","DOI":"10.1182\/blood-2003-06-2167"},{"key":"2019111702241833400_R30","doi-asserted-by":"crossref","unstructured":"Olsson B, Andersson P-O, Jernas M, et al. T-cell-mediated cytotoxicity toward platelets in chronic idiopathic thrombocytopenic purpura. Nature Med. 2003;9:1123\u20131124.","DOI":"10.1038\/nm921"},{"key":"2019111702241833400_R31","doi-asserted-by":"crossref","unstructured":"Vesely SK, Buchanan GR, Adix L, et al. Self-reported initial management of childhood idiopathic thrombocytopenic purpura: Results of a survey of members of the American Society of Pediatric Hematology\/Oncology, 2001. J Pediatr Hematol Oncol. 2003;25:130\u2013133.","DOI":"10.1097\/00043426-200302000-00009"},{"key":"2019111702241833400_R32","doi-asserted-by":"crossref","unstructured":"Gaines AR. Disseminated intravascular coagulation associated with acute hemoglobinemia or hemoglobinuria (D) immune globulin intravenous administration followed Rh0 for immune thrombocytopenic purpura. Blood. 2004;106:1532\u20131537.","DOI":"10.1182\/blood-2004-11-4303"},{"key":"2019111702241833400_R33","doi-asserted-by":"crossref","unstructured":"Kees-Folts D, Abt AB, Domen RE, Freiberg AS. Renal failure after anti-D globulin treatment of idiopathic thrombocytopenic purpura. Pediatr Nephrol. 2002;17:91\u201396.","DOI":"10.1007\/s00467-001-0763-4"},{"key":"2019111702241833400_R34","doi-asserted-by":"crossref","unstructured":"Cooper N, Woloski MR, Fodero EM, et al. Does treatment with intermittent infusions of intravenous anti-D allow a proportion of adults with recently diagnosed immune thrombocytopenic purpura to avoid splenectomy? Blood. 2002;99:1922\u20131927.","DOI":"10.1182\/blood.V99.6.1922"},{"key":"2019111702241833400_R35","doi-asserted-by":"crossref","unstructured":"George JN, Raskob GE, Vesely GE, et al. Initial management of immune thrombocytopenic purpura in adults: a randomized control trial comparing intermittent anti-D with routine care. Am J Hematol. 2003;74:161\u2013169.","DOI":"10.1002\/ajh.10424"},{"key":"2019111702241833400_R36","doi-asserted-by":"crossref","unstructured":"Kojouri K, Vesely SK, Terrell DR, George JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood. 2004;104:2623\u20132634","DOI":"10.1182\/blood-2004-03-1168"},{"key":"2019111702241833400_R37","doi-asserted-by":"crossref","unstructured":"Stasi R, Pagano A, Stipa E, Amadori S. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adults with chronic idiopathic thrombocytopenic purpura. Blood. 2001;98:952\u2013957.","DOI":"10.1182\/blood.V98.4.952"},{"key":"2019111702241833400_R38","doi-asserted-by":"crossref","unstructured":"Cooper N, Stasi R, Cunningham-Rundles S, et al. The efficacy and safety of B-cell depletion with anti-CD20 monoclonal antibody in adults with chronic immune thrombocytopenic purpura. Br J Haematol. 2004;125:232\u2013239.","DOI":"10.1111\/j.1365-2141.2004.04889.x"},{"key":"2019111702241833400_R39","doi-asserted-by":"crossref","unstructured":"Braendstrup P, Bjerrum OW, Nielsen OJ, et al. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adult refractory idiopathic thrombocytopenic purpura. Am J Hematol. 2005;78:275\u2013280.","DOI":"10.1002\/ajh.20276"},{"key":"2019111702241833400_R40","doi-asserted-by":"crossref","unstructured":"Bennett CM, Rogers ZR, Kinnamon DD, et al. Prospective phase 1\/2 study of rituximab in childhood and adolescent chronic immune thrombocytopenic purpura. Blood. 2005;107:2639\u20132642.","DOI":"10.1182\/blood-2005-08-3518"}],"container-title":["Hematology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/ashpublications.org\/hematology\/article-pdf\/2006\/1\/402\/1091465\/402_407ash.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/ashpublications.org\/hematology\/article-pdf\/2006\/1\/402\/1091465\/402_407ash.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,11,17]],"date-time":"2019-11-17T07:24:41Z","timestamp":1573975481000},"score":1,"resource":{"primary":{"URL":"https:\/\/ashpublications.org\/hematology\/article\/2006\/1\/402\/19756\/ITP-in-the-21st-Century"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,1,1]]},"references-count":40,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2006,1,1]]}},"URL":"https:\/\/doi.org\/10.1182\/asheducation-2006.1.402","relation":{},"ISSN":["1520-4391","1520-4383"],"issn-type":[{"value":"1520-4391","type":"print"},{"value":"1520-4383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,1,1]]}}}